高血压多种药物; treating high blood pressure with multiple medications

高血压的治疗一向给很多人带来困扰。血压该如何合理用药物控制总是一个不解的问题。很多人认为用药数量越少越好，其实并非如此：

研究证明，很多高血压的药品，盲目增加剂量会是副作用大大增加，而药效的增加幅度却非常小。如果您服用一个降血压的药品，但血压仍就偏高，先有的研究推荐少剂量添加另一类降血压的药品。用2味药达到的降压效果超出仅用一种药双倍剂量的效果的4倍之多。同时，不同类型的高血压药，药理不同，所以低剂量的2味药产生的副作用远远小于高剂量的一味药。 

如果您不介意吃多个药片，同时又对副作用有所顾虑，在您的医生提高药物剂量的时候，可以和您的医生讨论试用2味降血压药品的话题。 

Vitamin E as supplements NOT recommended routinely 减少维他命E的服用

Quite a number of patients are visiting the pharmacy for vitamin E supplements. I personally recommend against stand-along supplementation of vitamin E. Reasons are below,

vitamin E is an antioxidant that was marketed towards general health and boosting immune function many years ago. The marketing was based on the theory that antioxidants decrease free radicals in the body thus preventing cellular damage. Evidence did not exist in full strength then on the safety of supplementation. Multiple studies looking at such concern was published around 2004-2005, suggesting that supplementing with vitamin E can possibly cause HARM with NO BENEFIT in cardiovascular protection. It is suggested that vitamin E supplementation if necessay must be kept under 400IU daily and an intake of 400IU or greater has been shown to increase risk of heart failure minimally in high risk patients and increase all-cause-mortality with dose >400IU/day.

In addition, vitamin E has been noted to increase bleeding tendency in patients taking NSAIDs, Warfarin, ASA or other blood thinning products. It is suggested to limit supplementation to 200IU if necessary or discontinue supplementation if vitamin E is not necessary.

Vitamin E:
sources: nuts, seeds, vegetable oils
daily requirement ~22.4IU from natural sources daily for general population (value may vary with references)
Usual commercially available products, 200IU and 400IU from natural or synthetic sources

虫咬，野外植物过敏现象 - bug bites and plant contact allergy

虫咬或被植物蛰了过后，

1. 用水和肥皂洗净
2. 可以考虑用上敷药品 - Astringents, Oatmeal baths (Aveeno), Calamine Lotion，此类产品可以使皮肤舒服一些，止痒，晾干。
3. OTC非处方 hydrocortisone 也可以使用，但效果并没有处方类药品理想。如果情况不严重，不需要用hydrocortisone, 情况严重的话，建议见医生开处方类上敷皮质类固醇。
4. 口服过敏药效果未必理想，应为痒的感觉不完全是由于histamine release. 口服过敏药效果平平
5. 上敷过敏药，麻醉药（止痛药）以及抗生素也不建议，应为会刺激皮肤。

hydrocortisone和其他上敷皮质类固醇需1-2日才能见效，保留此类药为中等-严重蚊虫叮咬现象。

Hypoglycemia

These has been a lot of talk about treating hypoglycemia/low blood sugar,

Remain calm, Suggested treatment include - 15g of simple sugar (glucose or table sugar, etc), use 20g of simple sugar to correct severe hypoglycemia. This is about 3-4 glucose tablets, 5-6 hard candy and 120mL of REGULAR soda.

Suggest retesting 15min after a hypoglycemia episode,

and suggest a small meal after blood sugar has been corrected.

treatment of diarrhea - children

Always rehydrate.

Rehydration solutions are available and if diarrhea is not severe, rehydrate as needed. DO NOT over rehydrate with plain WATER. This may cause eletrolyte imbalance which can be dangerous as well.

Rehydration solution calculation (with rehydration solution)

Home-made rehydration solution - 1 teaspoon (5mL) of salt AND 8 teaspoon of sugar (40mL) in 1 litter of water. DO NOT use pop or certain juice, due to large amount of sugar. 

for mild-moderate dehydration,

50mL/kg over the first 4 hours (NOT ALL TOGETHER in one dose) 

moderate-severe dehydration, (must seek medical attention)

100mL/kg over the first 4 hours

rehydration should continue beyond 4 hours if needed. 

Plain water is harder to absorb than rehydration solution in case of diarrhea and plain water has no eletrolytes to replenish the loss.

Drugs

In case of suspected infectious causes - ex. unsanitized food, house hold, school, work place outbreak. Some drug therapy may not be used.

DO NOT use,

bismuth subsalicylate - Pepto Bismo - contains salicylate, not recommended in children. In addition, efficacy data is not firmly established.

Loperamide, Imodium - not approved to be used in children <2. Must consult physician <12. Risk of mental side effects with Imodium. 

Psyllium, metamucil - can be used with physician's guidance. Do not use products with laxative. 

Attapulgite - not recommended. very weak efficacy data. 

not suggesting adding niacin to statins?

Recent meta-analysis this January, 2013 suggests benefit of adding niacin to existing therapy to further alter lipid levels looking at current data available (11 trials, n=~10000).

The AIM-HIGH (n=3500, established CV disease) showed no benefit for hard end points (ex. first event of the composite of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for an acute coronary syndrome, or symptom-driven coronary or cerebral revascularization.)



Lavigne PM, Karas RH.The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013 Jan 29;61(4):440-6. doi: 10.1016/j.jacc.2012.10.030. Epub 2012 Dec 19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23265337?dopt=Abstract

The AIM-HIGH Investigators. Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy. N Engl J Med 2011; 365:2255-2267. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa1107579

an interesting article on myth about weight losing

Heard about this all over the media - sex only burns 21 Cal (or kcal) on average?
The original paper looks into different myths regarding weight losing. Part of this article touches on the subject of sexercise. It calculated the amount of energy needed for sex using the average energy expendature per hour times the average length of sex (only 6 minutes! - Bohlen JG, Held JP, Sanderson MO, Patterson RP. Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med 1984;144:1745-1748) This gives the shocking number 21 Cal per sexual activity!

We might as well spend 20 minutes watching TV, we burn the same amount of energy...

Original source - http://www.nejm.org/doi/full/10.1056/NEJMsa1208051#t=articleDiscussion
published on new england journal of medicine.